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Title
Text copied to clipboard!Credentialing Analyst
Description
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We are looking for a Credentialing Analyst to join our healthcare administration team. The Credentialing Analyst plays a critical role in ensuring that healthcare providers meet all necessary qualifications and standards to deliver care. This position involves collecting, verifying, and maintaining documentation related to medical staff credentials, licenses, certifications, and other regulatory requirements. The ideal candidate will have a strong attention to detail, excellent organizational skills, and a solid understanding of healthcare compliance standards.
As a Credentialing Analyst, you will be responsible for managing the credentialing and re-credentialing process for physicians, nurses, and other healthcare professionals. You will work closely with internal departments, external agencies, and healthcare providers to ensure that all documentation is accurate, complete, and up to date. This includes verifying education, training, licensure, board certifications, work history, and malpractice history. You will also be responsible for maintaining credentialing databases and ensuring compliance with federal, state, and organizational policies.
In this role, you will need to stay current with industry regulations and accreditation standards, such as those set by The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), and Centers for Medicare & Medicaid Services (CMS). You will also assist in audits and prepare reports for internal and external stakeholders. Strong communication skills are essential, as you will be required to interact with a variety of professionals and organizations.
This is an excellent opportunity for someone with a background in healthcare administration, medical staff services, or compliance who is looking to contribute to the quality and safety of patient care. If you are detail-oriented, proactive, and passionate about healthcare quality, we encourage you to apply.
Responsibilities
Text copied to clipboard!- Verify provider credentials including education, licensure, and certifications
- Maintain accurate and up-to-date credentialing files and databases
- Coordinate initial credentialing and re-credentialing processes
- Ensure compliance with regulatory and accreditation standards
- Communicate with providers and external agencies to obtain required documentation
- Prepare reports and assist with audits
- Track credentialing deadlines and follow up on missing information
- Collaborate with internal departments to support provider onboarding
- Monitor changes in credentialing regulations and update procedures accordingly
- Assist in resolving credentialing issues or discrepancies
Requirements
Text copied to clipboard!- Bachelor’s degree in healthcare administration or related field preferred
- 2+ years of experience in credentialing or medical staff services
- Knowledge of credentialing standards (TJC, NCQA, CMS)
- Strong attention to detail and organizational skills
- Excellent written and verbal communication skills
- Proficiency in credentialing software and Microsoft Office Suite
- Ability to manage multiple tasks and meet deadlines
- Familiarity with healthcare compliance and regulatory requirements
- Experience working with confidential information
- Certification as a Certified Provider Credentialing Specialist (CPCS) is a plus
Potential interview questions
Text copied to clipboard!- Do you have experience with provider credentialing processes?
- Are you familiar with TJC, NCQA, or CMS standards?
- What credentialing software have you used in the past?
- How do you ensure accuracy when verifying credentials?
- Describe a time you resolved a credentialing issue.
- Are you certified as a CPCS or willing to obtain certification?
- How do you stay updated on changes in credentialing regulations?
- What strategies do you use to manage multiple credentialing deadlines?
- Have you participated in any credentialing audits?
- What is your experience with maintaining credentialing databases?
